情感障碍对癫患者认知障碍影响的事件相关电位研究

目的应用事件相关电位研究和探讨不同抗癫痫药对癫痫患者认知功能的影响以及情感障碍对癫痫患者认知障碍的影响。方法收集湛江中心人民医院神经内科门诊和住院的癫痫患者320例,正常对照组56例。分别进行韦氏智能测定和情感测定,同时结合抗抑郁剂治疗,并应用事件相关电位P300、N400研究,对比分析癫痫患者认知功能和情感障碍的特征。结果386例癫痫患者中,认知水平低于正常者达76．940。结果显示丙戊酸钠、妥泰、卡马西平单药服药组之间认知水平无差异,但药物联合应用认知功能损害严重。且患者职业、文化程度、病程、发作次数、用药选择以及是否存在脑部继发性疾病等对认知功能影响显著。伴随着认知功能和情感障碍,癫痫患者P300和N400潜伏期明显延长、波幅降低。百忧解治疗后R300和N400潜伏期和波幅明显改善,且颞顶叶脑区的波幅明显升高。结论抗癫痫药可造成癫痫患者认知功能的损害,单药应用较联合用药对癫痫患者认知功能损害轻。抗抑郁治疗可改善癫痫患者的认知功能,认知事件相关电位也明显改善。     

情感障碍对癫痫患者认知障碍影响的事件相关电位研究

目的应用事件相关电位研究和探讨不同抗癫痫药对癫痫患者认知功能的影响以及情感障碍对癫痫患者认知障碍的影响。方法收集湛江中心人民医院神经内科门诊和住院的癫痫患者320例,正常对照组56例。分别进行韦氏智能测定和情感测定,同时结合抗抑郁剂治疗,并应用事件相关电位P300、N400研究,对比分析癫痫患者认知功能和情感障碍的特征。结果386例癫痫患者中,认知水平低于正常者达76．940。结果显示丙戊酸钠、妥泰、卡马西平单药服药组之间认知水平无差异,但药物联合应用认知功能损害严重。且患者职业、文化程度、病程、发作次数、用药选择以及是否存在脑部继发性疾病等对认知功能影响显著。伴随着认知功能和情感障碍,癫痫患者P300和N400潜伏期明显延长、波幅降低。百忧解治疗后R300和N400潜伏期和波幅明显改善,且颞顶叶脑区的波幅明显升高。结论抗癫痫药可造成癫痫患者认知功能的损害,单药应用较联合用药对癫痫患者认知功能损害轻。抗抑郁治疗可改善癫痫患者的认知功能,认知事件相关电位也明显改善。     

抗抑郁剂治疗前后癫痫患者的认知障碍和情感障碍研究

目的探讨抗抑郁剂对癫痫患者认知功能和情感障碍的影响。方法收集癫痫患者320例,正常对照组56例。320例癫痫患者随机分为百忧解治疗组和常规治疗组(每组160例)。百忧解治疗组在常规抗癫痫治疗的同时加用百忧解抗抑郁治疗,每日20mg,连服12周。各组分别进行韦氏智能测定和情感测定,并应用事件相关电位P300、N400研究,对比分析癫痫患者认知功能和情感障碍的特征。结果320例癫痫患者中,智能水平低于正常者(IQ值≤90分)259例(80.9%),智能水平明显低下者(IQ值≤70分)168例(52.8%);246例(76.9%)伴有抑郁,283例(88.4%)伴有焦虑。联合应用抗癫痫药组认知障碍和情感障碍均较单药服药组严重。伴随着认知功能障碍和情感障碍,癫痫患者P300和N400的潜伏期明显延长、波幅降低。治疗12周后常规治疗组和百忧解治疗组认知功能和情感障碍均有改善,P300和N400潜伏期和波幅亦明显改善,且百忧解治疗组的改善更加明显。结论抗癫痫药可造成癫痫患者认知功能的损害,单药应用较联合用药对癫痫患者认知功能损害轻。伴随着认知功能障碍和情感障碍,癫痫患者P300和N400潜伏期明显延长、波幅降低。抗抑郁治疗可改善癫痫患者的认知功能。     

抗癫(痫)药物对癫(痫)病人事件相关电位P300的影响

目的:评价托吡酯(topiramate,TPM)与拉莫三嗪(lamotrigine,LTG)对癫痫患者认知功能的影响.方法:60例新确诊癫痫患者随机分为两组:TPM单药治疗组32例,LTG单药治疗组28例;用药前及用药2个月后分别检测事件相关电位(event related potentials,ERP) P300的潜伏期(ms)及波幅(μV),并比较两种药物对P300的影响.结果:TPM治疗后,患者P300潜伏期延长、波幅降低,与治疗前相比,差异有显著意义(P＜0.01),与对照组(未用药的24名正常人)相比,差异有显著意义(P＜0.01),与LTG相比,差异有统计学意义(P＜0.05),LTG治疗组P300潜伏期延长、波幅降低,但与治疗前相比和与对照组相比,差异均无统计学意义(P＞0.05).结论:TPM与LTG都是控制癫(痫)发作较理想的新型抗癫(痫)药物,服用治疗剂量范围内TPM对患者P300产生较明显的影响,而LTG对癫(痫)患者P300影响较小.服用TPM可能导致癫(痫)患者出现认知功能障碍,而服用LTG对癫(痫)患者的认知功能不仅没有损害,甚至可能有一定的改善作用.     

缺血性白质脑病患者事件相关电位研究

目的探讨缺血性白质脑病患者认知障碍、情感障碍的特点及规律,及对事件相关电位进行研究。方法收集缺血性白质脑病患者480例和正常对照86例,分别应用MMSE和Hamilton焦虑量表和24项版本抑郁量表进行测评,并进行事件相关电位P300、N400检测。结果缺血性白质脑病不同分级认知障碍、情感障碍差异有统计学意义,随着脑白质损害加重、分级增高,认知障碍和情感障碍加重,事件相关电位P300和N400潜伏期明显延长,波幅明显降低。结论缺血性白质脑病可造成患者严重认知、情感障碍,事件相关电位P300、N400可作为早期诊断缺血性白质脑病认知障碍的客观指标。     

左乙拉西坦治疗各型癫(癇)100例临床疗效观察

目的 观察左乙拉西坦(开普兰)治疗各型癫(癇)的疗效.方法 用开放性试验的方法对100例癫(癇)患者进行了添加转单药以及首诊单药的开普兰治疗,观察其疗效及不良反应.结果 总有效率46.0%,控制率15.0%,对各型癫(癇)均有效.不良反应出现率17.0%.结论 开普兰是一种安全、有效的抗癫(癇)药物,对各型癫(癇)均有效.     

偏头痛与癫(癇)关系的临床观察

目的 探讨偏头痛与癫(癇)的关系.方法 收集偏头痛患者及癫(癇)患者病史、临床表现、脑电图等资料,进行回顾性分析.结果 偏头痛组患者及癫(癇)组患者经对照研究分析,相对危险度(RR)值均位于95%置信区间内.结论 偏头痛与癫(癇)存在双向联系,偏头痛可能是癫(癇)的病因或危险因素,癫(癇)也可能引起偏头痛样发作.     

癫(癇)患者血清和脑脊液中抗心磷脂抗体的测定及临床意义

目的 探讨癫(癇)患者血清和脑脊液中抗心磷脂抗体的测定及临床意义.方法 采用酶联免疫吸附试验(ELISA法)检测45例癫(癇)患者及43例健康人群血清和脑脊液中抗心磷脂抗体水平.结果 癫(癇)组血清和脑脊液中抗心磷脂抗体均明显高于健康对照组(χ2=36.42、35.73,P<0.01).结论 癫(癇)发作时患者血清和脑脊液中抗心磷脂抗体水平增加,癫(癇)患者存在自身免疫功能的紊乱.     

癫癇患者认知功能影响因素的研究

目的：研究癫痫患者认知功能的影响因素。方法：对166例癫痫患者进行认知评定。认知评定工具：听觉词语测验、逻辑记忆测验、数字符号转换测验、Stoop字色干扰测验、连线测验、言语流畅性测验、Rey—Osterrieth复杂图片测验及Boston命名测验。影响因素与认知功能评分之间采用一元线性相关及多元逐步回归分析。结果：患者年龄、性别、文化程度、起病年龄、病程、发作频率、发作持续时间、全身强直阵挛发作（GTCS）、复杂部分性发作（CPS）及抗癫癇药物数量与患者的认知功能有相关性。结论：癫癇患者的起病年龄与其认知损害成正比，病程越长对癫癇患者的认知损害越明显，原发或继发全身性强直阵挛发作与言语功能损害、复杂部分性发作与言语记忆损害之间的关系密切，用药种类与记忆、注意力以及精神运动能力的损害有关。     

心理干预和健康教育对癫(癎)患者认知功能影响的研究

目的 研究和探讨心理干预和健康教育对癫(癎)患者认知功能的影响.方法 收集湛江中心人民医院神经内科门诊和住院的癫(癎)患者386例,分别进行韦氏智能、情感、生存质量等测定,并进行心理干预和健康教育,观察治疗前后认知功能的差异.结果 386例癫(癎)患者中,认知水平低于正常者(IQ值≤ 90分)297例(76.94%), 认知水平低下者(IQ值≤70分)217例(56.22%).回归分析显示患者职业、文化程度、病程、发作次数等对患者认知功能影响显著.相关分析显示认知功能水平与患者的焦虑抑郁情感评分呈显著负相关,与患者的情绪、精力、认知功能、用药顾虑显著相关,而患者的焦虑抑郁情绪与其情绪、精力、认知功能显著相关.心理干预治疗后,患者认知功能、情感障碍、生存质量明显改善.结论 抗癫(癎)药可造成癫(癎)患者认知功能的损害,积极有效规范化的心理治疗和健康教育对患者的认知功能、情感障碍、社会生存质量均有明显的改善.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

A contribution to the study of the architecture of the autonomic nervous system of the digestive tract of the rat

Summary The distribution of aminergic and non-aminergic nerve fibres to the different constituents of the wall of the digestive tract in various regions is described. Aminergic fibres synapse with all nervous perikarya. Densely interlacing networks of nerve fibres are found in both layers of the tunica muscularis and in the lamina muscularis mucosae. A finely meshed plexus is observed in relation to the wall of the blood vessels in the wall of the gut. There are many fibres connecting the muscular and the vascular plexus. No nerve fibres have been observed in direct relation to the epithelium.The functional implications of these findings are discussed.